PMT18-01720 City of Menifee Permit No.: PMT18-01720
29714 HAUN RD. Type: Residential Plumbing
-C;10ErELl� MENIFEE, CA 92586
-"�S.A—e MENIFEE Date Issued: 04/19/2018
PERMIT
Site Address: 28618 MIDSUMMER LN, MENIFEE, CA Parcel Number: 364-211-010
92584 Construction Cost: $800.00
Existing Use: Proposed Use:
Description of REMOVE AND REPLACE WATER HEATER- SAME SIZE(50 GALLON GAS),SAME LOCATION.
Work:
Owner Contractor
KATHLEEN HAVARD ALL STAR WATER HEATERS INC
28618 MIDSUMMER LANE 30300 PUERTO VALLARTA WAY
MENIFEE, CA 92584 MENIFEE,CA 92584
Applicant Phone:9513010067
KATHLEEN HAVARD License Number:812894
28618 MIDSUMMER LANE
MENIFEE,CA 92584
Phone:9513035054
Fee Description Q�t( Amount($)
Water Heater 1 83.00
Building Permit Issuance 1 27.00
GREEN FEE 1 1.00
General Plan Maintenance Fee-Plumbing 1 4.15
$115.15
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit_Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No.��o�rQ By my signature below I acknowledge that,except for my personal residence
Expires 30 _Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legallysell a structure that 1
have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following websile:
by Section 3700 of the Labor Code,for the performance of work for which
this permit is issued. www.leginfo.ca.gov/calaw.html.
Policy fE Date
pd have and will maintain worker's compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which 1<<Vy my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier
LC with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy tt EAj/ /� 7y2f Expires - enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROP lY, NER OR AUTHORIZED AGENT
o I certify that in the performance of the work for which this permit is issued, r , ` r
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE It V �.
worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION
subject to the worker's compensation provisions of Section 3700 of the Labor
Code,I shall forthw co ply with those provisions. Will the applicant or future building occupant handle hazardous material or a
mixture containing a hazardous material equal to or greater that the
Applicant n Date amounts specified on the Hazardous Materials Information Guide?
WARNING:1.A SECURE WORKER'S COMPENSATION COVERAGE IS ❑Yes 'o No
UNLAWFUL,AN6`SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes ❑No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes ❑No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractor's License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
hazardous material reporting.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes o No
Business and Professions Code).Any city or county that requires a permit to Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY OWNER OR AUTHORIZED AGENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIR AND PAINTING(RRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
0 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.epa.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code;The Contractor's State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because:
❑1,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractor's State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
i
DATE LAMI __PERMIT/PLAN CHECK NUMBERPT - = ol-Ia�
TYPE: 0 COMMERCIAL Q✓RESIDENTIAL 0 MULTI-FAMILY 0 MOBILE HOME 0 POOL/SPA 0 SIGN
SUBTYPE: 0 ADDITION C}ALTERATION DEMOLITION FLECTRICAI C, MECHANICAL
0 NEW ZPLUMBING ,• RE-ROOF-NUMBER OF SQUARES _ r
--
DESCRIPTION OF WORT{ Replace existing water heater. Same size and location.
City of Menif
Dem.
PROJECT ADDRESS 28618 Midsummer Ln _
ASSESSOR'S PARCEL NUMBER APR 9-2018
5��74�� - LOT rR:1!_f i
OWNER NAME Kathleen Havard Q
° ADDRESS 28618 Midsummer Ln
PHONE 951-303-5054 EMAIL
APPLICANT NAME Sierra Sprague j
ADDRESS 30300 Puerta Vallarta
PHONE 951-301-0067 EMAIL allstar.sierra@gmaiLcom
CONTRACTOR'S NAME Sierra Sprague cl}VINNER BUILDER. 0 YES NO
BUSINESS NAME All Star Water Heaters
ADDRESS 30300 Puerta Vallarta Way
! PHONE 951-301-0067 EMAIL allstar.sierra@gmaiLcom
CONTRACTOR'S STATE LIC NUMBER 812894 LICENSE CLASSIFICATION C36
VALUATION$ 800.00 SQ FT L SQ FT
_ n
APPLICANT'S SIGNATURE .c ._ ——._.._ __. . =DATE
—_ -....._
DEPARTMENT DISTRIBUTION 1 CITY OF MENIFEE BUSINESS LICENSE NUMBER t'
I
BUILDING PLANNING ENGINEERING FIRE GRE.EI'J 5JV71P
INVOICE 1_ PAID AMOUNT
AMOUP41 I IC3. CASH CHECKH CREDITCARU VISAJNIC
-—a
PLAN CHECK FEES I PAID AMOUN T 0 CASH O CHECK N `-}CREDIT CARD VISA MC 4
OWNER BUILDER VERIFIED YES No DL NUMBER
y n NOTARIZED LETTER ;% YES �? NO
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